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COUNTY OF SAN JOAQUIN Date: 3 114 167 <br /> DEPARTMENT OF PUBLIC WORKS Received by <br /> CR# C3 3 <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERAHT APPLICATION <br /> APPLICANT OFFICE USE ONLY <br /> JOB# 11005ISSUE DATE / / <br /> N,� APNZ ^o <br /> ar -G15-G-� FEE DUE T <br /> t� e"I�p 6.j EXP.DATE DRIVEWAYS: <br /> Address � STREET P�ETZ ' <br /> ���r c U � �v AREA <br /> ! QUAD <br /> C�,State-Z Cod TYPE D ` <br /> r�L 6�I i-C LA C- 4 . J FORMS S,�1e <br /> 17 <br /> (Area Code)Tele�hone NOTE <br /> SITE INFORMATION <br /> �a Pcel07r'sNee�n1 <br /> fJ�eeC j A D DRIVEWAY QUANTITY WIDTHS <br /> Ci ,State-Zip C?4e TYPE <br /> � FRONTAGE <br /> ►�� A�i�1.aG' C,.R+.� � �b <br /> AGRICULTURE <br /> COMMERCIAL <br /> (Area Code)Telephone <br /> INDUSTRIAL @ R/vV <br /> RESIDENCE <br /> CONTRACTOR PAVED FRONTAGE <br /> LENGTH: Ft. X WIDTH: Ft. <br /> Name <br /> Address The undersigned hereby applies for permission to encroach on County Highway <br /> Right-of-Way on the Wfes f' side of Ore5Cc,# led <br /> City,State-Zip Code approximately feet/mile of <br /> by installing <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> Will this project be self-installed? _NO YES Contractor's License <br /> A==\Per AppTormOnvewayPaved&outage <br />